Moralisk stress - professionella möten med moraliskt laddade situation

I den här artikeln beskrivs den moraliska stressreaktionens karaktär och hur den påverkas av individuella och kontextuella förhållanden. Vi presenterar ett antal starkt moraliskt stressande situationer som professionell insatspersonal kan möta. Den moraliska stressreaktionen ger olika kortsiktiga reaktioner och påverkar oss fysiologiskt, muskulärt, kognitivt och emotionellt. Moralisk stress kan leda till moralisk skada på lång sikt och innebära en förändring av den egna moraliska övertygelsen. Kronisk moralisk stress kan ge kroppsliga symtom. Moralisk stress behöver inte bara ha negativa effekter. Moralisk stress från svåra situationer kan även ha en positiv påverkan. Slutligen redogör vi för ett antal problemlösnings- respektive känslohanteringsinriktade strategier som militär personal, poliser och andra professionella yrkesgrupper inom insatsyrken använder sig av

Moral stress and coping: relationship with long-term positive reactions and PTSD indication in military personnel

This study investigates the relationship between moral stress reactions and resulting coping efforts in severely morally challenging situations. Long-term positive reactions and post-traumatic stress disorder (PTSD) indicators fol-lowing morally challenging situations are also studied. The sample consisted of cadets and officers (n = 332) from Norway and Sweden. Long-term positive reactions were found to be associated with limited moral stress reactions during the challenging episode and frequent use of acceptance and positive reappraisal coping strategies. Long-term high scores on a PTSD indicator scale covaried with high scores on Openness, a strong moral stress reaction, and frequent use of instrumental coping strategies. The main conclusion is that the immediate moral stress reaction and coping strategies following morally challenging situations appear to be related to both positive long- term reactions and to indicators of PTSD.publishedVersio

Moral stress and coping: relationship with long-term positive reactions and PTSD indication in military personnel

This study investigates the relationship between moral stress reactions and resulting coping efforts in severely morally challenging situations. Long-term positive reactions and post-traumatic stress disorder (PTSD) indicators fol-lowing morally challenging situations are also studied. The sample consisted of cadets and officers (n = 332) from Norway and Sweden. Long-term positive reactions were found to be associated with limited moral stress reactions during the challenging episode and frequent use of acceptance and positive reappraisal coping strategies. Long-term high scores on a PTSD indicator scale covaried with high scores on Openness, a strong moral stress reaction, and frequent use of instrumental coping strategies. The main conclusion is that the immediate moral stress reaction and coping strategies following morally challenging situations appear to be related to both positive long- term reactions and to indicators of PTSD.publishedVersio

Avstand og nærhet som militæretisk utfordring

Soldater er i dag i besittelse av våpensystemer som gjør det mulig for dem å ta liv på stor avstand. I denne studien drøfter vi hvilken betydning avstand og nærhet har for opplevelsen av moralsk stress og moralsk ansvarsfølelse i en militær kontekst. Studien viser at psykologisk nærhet har stor betydning for vårt moralske engasjement. Soldatene opplever mest moralsk stress og har størst moralsk ansvarsfølelse i situasjoner som involverer mennesker de har psykologisk nærhet til. Da har en eventuell fysiske avstand liten innvirkning på den moralske ansvarsfølelsen. Har soldatene stor psykologisk avstand til personer eller grupper, reduseres det moralske engasjementet. Fysisk avstand kan være med på å forsterke denne tendensen. I situasjoner der soldater befinner seg på lang avstand til mennesker de ikke har noe psykologisk forhold til, er det lite moralsk stress knyttet til bruk av vold. Samtidig vet vi at både psykisk og fysisk nærhet kan være problematisk i en moralsk kontekst. Ingen overgrep er verre enn dem som blir utført av personer man har psykologisk nærhet til. Opplever man psykologisk nærhet til autoritære personer med voldelige trekk, kan dette innebære at det oppleves problematisk å handle etter egen overbevisning. Noen av de mest brutale overgrepene i krig skjer i situasjoner der overgriperen har fysisk nærhet til ofrene

Å ta liv i kamp. - En operativ, moralsk og psykologisk utfordring

I denne studien kartlegger vi hvordan det oppleves å ta liv i kamp. I forlengelse av det drøfter vi hva som skal til for å bli i stand til å drepe i skarpe operasjoner. Studien viser at soldater ikke opplever moralsk stress når de tar liv i situasjoner der de selv er truet. Våre funn peker i retning av at det er naturlig for mennesker å ta liv når situasjonen tilsier at det er helt nødvendig for å overleve samtidig som den sosiale rammen anerkjenner handlingen. Trening som vektlegger at soldater utsettes for sterkt gruppepress og rollemodeller med sterk autoritet, er ikke nødvendig for å sette soldater i stand til å drepe. Våre funn viser at soldater som har tatt liv i situasjoner der de har vært i livsfare, ofte opplever mestring og personlig vekst (PTG) etter hendelsen. I studien referer vi til et kvalitativt forskningsprosjekt der vi har intervjuet 28 soldater. 1 Vi referer også til et kvantitativt materiale der 82 soldater deltok. I denne studien drøfter vi våre funn i relasjon til ulike teoretiske modeller som forsøker å svare på vår problemstilling

Dendritic and lymphocytic cell infiltration in prostate carcinoma

We examined the distribution of CD1a+ cells and CD8+ and CD4+ T lymphocytes in prostate cancer (PCa) and correlated these with clinicopathological parameters. We also investigated whether the distribution of these cells was related to the expression of the cell membrane protein B7-H3, a putative negative regulator of the immune response expressed on PCa cells. A cohort of 151 PCa patients treated with radical prostatectomy (RP) was followed prospectively from 1985 until 2006 with a median follow-up of 9 years. Whole-mount sections of PCa specimens were immunostained to identify immune cells. A low number of CD1a+ cells was significantly associated with a high Gleason score and high pathological stage of pT3. The number of CD1a+ cells correlated significantly with the number of intratumoral and stromal CD8+ and stromal CD4+ lymphocytes. Kaplan-Meier analysis showed a tendency toward impaired biochemical progression-free survival in patients with few CD1a+ cells within their RP specimens. The expression of B7-H3 correlated inversely with the number of CD1a+ cells and intratumoral CD4+ lymphocytes; there was a trend for a similar inverse relationship between B7-H3 expression and the number of CD8+ lymphocytes. Our findings suggest that high-grade prostate carcinoma cells manipulate the immune system and that these changes contribute to the mechanism underlying tumor escape from immune surveillance

SHBG is an important factor in stemness induction of cells by DHT in vitro and associated with poor clinical features of prostate carcinomas.

Androgen plays a vital role in prostate cancer development. However, it is not clear whether androgens influence stem-like properties of prostate cancer, a feature important for prostate cancer progression. In this study, we show that upon DHT treatment in vitro, prostate cancer cell lines LNCaP and PC-3 were revealed with higher clonogenic potential and higher expression levels of stemness related factors CD44, CD90, Oct3/4 and Nanog. Moreover, sex hormone binding globulin (SHBG) was also simultaneously upregulated in these cells. When the SHBG gene was blocked by SHBG siRNA knock-down, the induction of Oct3/4, Nanog, CD44 and CD90 by DHT was also correspondingly blocked in these cells. Immunohistochemical evaluation of clinical samples disclosed weakly positive, and areas negative for SHBG expression in the benign prostate tissues, while most of the prostate carcinomas were strongly positive for SHBG. In addition, higher levels of SHBG expression were significantly associated with higher Gleason score, more seminal vesicle invasions and lymph node metastases. Collectively, our results show a role of SHBG in upregulating stemness of prostate cancer cells upon DHT exposure in vitro, and SHBG expression in prostate cancer samples is significantly associated with poor clinicopathological features, indicating a role of SHBG in prostate cancer progression

Immunohistochemistry of SHBG expression in prostate cancer tissues.

<p>(A) Positive and negative control of SHBG in liver tissues. (B) Weak SHBG positivity is shown in a benign prostate tumor and strong SHBG immunoreactivity is revealed in a malignant Gleason score 8 cancer tissue. (C) Representative immunohistochemical images of different scores of prostate cancer samples are shown. Bar scale in all of the images is 150 µm.</p